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� <br /> ---. <br /> APPLiCAT10.. �OEi COIdS'6RifiC`T1.rN t��RWli7' `',','�°" <br /> TO BE COMPLETED IN INK—PLE.>SE PRINT �� <br /> ,� � <br /> carv cr� <br /> everett HEATING SYSTEM ❑GAS � ELECTRIC ❑ � <br /> BUILDINu' DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COM9INATION ��UILDING !(ECHANICAL �LUMBING SIGN <br /> G1':6eR 1lML ADDRE55 GIT! ZIP PN04c <br /> C�;-+- o��� ,� 3za� C�a. s� ��E,ecF� 98�� 2s`'�=BG� _ - <br /> lE�::'.t r MRILADDRESS GRY ZIP PNONE <br /> j/��t�G <br /> '.ei.MREGTOR�E51GNEfl MPILAO�RE55 GTV ZiC PNONE <br /> �r� /�' ¢9IC rcu ul/.(,�pe�ccNSi S&r�i�c `I8!/9 — N/6G �.Bf -°fot� _ <br /> �T1 h N ,N�PqL C0!1TRAGTOR MAIL A�ORES�S,/ CITY 2iP PNONE LiGENSE♦ <br /> z��x ��cr�� �REST �%�sr !`�wci�`� 355-lJ9'f� — <br /> > ~ MECHnNICALGONiR<LTON MRI�ADDHE55 CiTV ZIP PHGN[ LILENSE� <br /> H C/� <br /> F'"� x^}^ — CrtY ZIP PHOHE UCENSE• <br /> H] ��-i PLNABINGCONTR/.CiGR MNLADDRE55 <br /> M� C� - <br /> �3� _— <br /> � H� LLA550�WORK . <br /> y H �NEW . A�DITION � ALTERATION REPAIR . DEMOLITION �.-. WOODSTOVE/FRPL INSERT � �: BUILOING RELOCATION <br /> C$ /� COVTAC�R501�AtlD PNON!NO��p� / <br /> � y� CO'lRAGTPFIGEOFWOR� �' �� �� I ' �v n�� 1 NO /l_�._– <br /> O H DESCRiPEWORNAND50U/AEFOpi4GE'NVOWEO /�� eON�PEf� txo« <br /> ) L <br /> H n o i31� e6N6Qf/� r�a 2�< SC..n 2� �9 7 <br /> 4]� O pnoa SEOWEOFpWLDiNG I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �"� q APPLICAfION AND KNOW THE SAIdE TO BE TRUE AND CORRECT.ALL <br /> Z H 3 F'IUnPlDAT/ON � TE"`�l <br /> ta., y z �ecn�osscr+��Tio��oFaaoaEarvis wNee�owoannacHrouacowEsi PROVI510NS OF LAWS AND ORD�tJANCES GOVERNING THIS TYPE OF <br /> WORK WILL 8E COAIPLETED'.NIiH WHETHER SPECIFIED HEREIN OR <br /> ~y io* eeoeK �F NOT. THE GRANTING 0= A PEF.MIT OOES NOT PRESUME TO GIVE <br /> � �H AUTHORITY TO VIOLAI E OFl GINGEL THE PROVISIONS OF ANY <br /> O Cy[/� OTHER STATE OR LOCAL LAW REGULATING CONSTRLICTION OR THE <br /> � �r PERFORMANCE OF CONSTRUCTIOId.THAT I AM AUTHORIZED BY THE <br /> � � OWNER OF THIS PRCPERTV TO PFRPv`RM THE WORK FOR WHICH <br /> Z HCA APPLICATION IS MADE AND I COMPLV VliTH THE STATE <br /> y �� CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> iiGtUiIIREOF OI.L 0 ORFUi O ED4 NT TE �.� <br /> �-,c-. ��.�.�r X �"Pl���'���+ � . � /� � , <br /> C.G.e t�t,,,.�..�r .�-� -- cv-�..�.��2..w��-, _C��±, y"——�"�� <br /> �r�:ECi A�DRE55 --- �Iiry <br /> APVI i;.nNl$GiTV BUS�M1E tiS UGEfLE ND AI .USV�le455 NAV c � "^– <br /> � <br /> PLUMI3ING MECNANICAL <br /> �� "'� NO. TYPF OF FIXTURE OH ITEM FEE NO. TYPE OF EOVIPMEN�f FEE <br /> """" N7�TER CLGSET(TUILET) AC-A HNDLG UtJITS-N.P_ _ <br /> �+ BATHTUB FORCED AIF SYSTEMS-B.ill. A7 E.A. <br /> .m .�. LAVATOR�_�WASH BASIN) UNIT HEATEFS-8 T.U. �d_ __ <br /> � . ;� SHOWEH CLOTHES DRYEFlS <br /> KITCNi3N SINK 8 DISP VENTILATION PAN _ _ <br /> DISHyJqSHER RANGE HOOD _ _ <br /> LAUNDRY TRAY WATER HEATER _ <br /> " "'� CLOTHES WASHER _ W�D STOVE ' __ <br /> URINAL h1ETAL PIREPLACE 8 CHIMNEY y_ <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> o ,., I FLOOR DRNN NEAT PUMP __ <br /> BACKFLOW PREVENTERS GAS PIPING _. <br /> ROOF ORAINS-RAINLFADERS [XHAUST FAN <br /> B- "'' SINK�SERVICE-BAR,ETC.) � <br /> .. ,� <br /> '��`� SUB TOTAL 5 _ :iUB TOTAL 5 <br /> PERMIT S —� __ PEflA11T 5 <br /> ' , TOTALFEE S 70TALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> RiCIliG@iOACN BEARSETOdCK SIpE5Eif1Af.N �IANLH[CKNt11APLi1 FEE ��r RECEIPiNO. <br /> /� I <br /> �/ � � j .�` yr�J�r_C�CA, "F!/b. '!/�.�- ✓ <br /> use zor+s �n*naea vncnr�i sire FEES/ VAL ATION FEE T_ <br /> �/ (/� +� � � 1 � <br /> dUILDING �;(J�_��{�! �IQ �� <br /> �rVCOlCONISALlOWABIE IYPEOfGON9PC10Al accur.�rn MOnuNEIUNGuxns '—" <br /> � ��j �j �Lc�ae��v p�UMBiNG <br /> IRI� = In n- i - " <br /> Si)EOFB�OG NOAfSiORIES BOSEMENT MECHANIGAL <br /> ID �' I --� �� � ;— <br /> OCNPANLYLOA� FIREyPflNNLERSR[O'D 11[IGNTLIMIiAiION �ODITIONALPIANCHECK /'/. /��� ' � I <br /> .� ����.� OTTiER __ _"_ <br /> �VEASON FOR SPRINKLER$ , <br /> �I�1���CT�'-�F.';- �-C'��.', I � �'I ? '� � . ' STATE BUILOING SUFCHARGE ,. � _ <br /> ciinnE�Y PLANSRPPROV2B�Y CITYOFEIIERETT PUBLICWORKS � —i <br /> � LOCAL SA�.ES �`�� <br /> TAX CODE IS 31U5 TOTpi � �` �' / <br /> �` �/ <br />